BP5542BUILDING PERMITAPPLICATIO~V
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair Nebraska 68008
(402) 426-4191 Permit
5542
Application Date: ~ ~ ~ Issue Date: f (J `~i - ~ > Permit Fee: $ ~~
JOB ADDRESS
a~L ~ ~~ h
1 LEGAL
DESCR. LOT NO. ~~ BLK. TRAC ~ ~c~-' ^ SEE ATTACHED SHEET
2. OWNER ~MAILADDRESS ~ / ZI ~PHON 1 ~
,t.ti.
3. CON AC R MAILADDRESS PHONE LICENSE NO.
USE OF ILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
], Sq. Footage of CtUre (Including Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ ~ -
10. Floodplain: Floodway Yes ^ No ^ Dev. Permit Elev. Cert.
Fringe Yes^ No ^ BFE
C~
J
11. Current Zoning: Site Plan Attached ^ Comple~~
ans attached ^
12. State Fire Marshall Required: Yes ^ No^ Approximate Completion Date ~
17 9.3
Inspections Required and Fees
13. Special Use Permit Required: Yes ^ No ^ utilities
Sewer Tap Water Tap
14. Variance Required: Yes ^ No ^
sewer Water Service
15. Minimum Setbacks: Front Side Rear septic Remote
16. Sidewalk Re uired: Yes No Waiver A roved
q ^ ^ pp ~ 2-r5-~3~r _~Y'~8~' `
Building D~; 1~
LI TIO ACCEPTED BY ~ LANS CHECKED BY APPROVED FOR ISSUANCE BY Footings Drywall
(before finish)
~~ ~' ~~~
NOTICE Framing Final
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, and septic systems. By my signature below, I achnowledge that payment of the Electrical
building permit application fee does not constitute issuance of this building permit. I further
agree that construction covered by this permit application shall not be commenced until I Rough-in Fixtures
have received a copy of this application form signed by the Building Inspector and stamped
~
'
IAPPROVEDI.
I hereby agree to perform the proposed work in accordance with the specifications set forth Final Permanent Service
above and in accordance with the codes/ordinances of the City of Blair and the State of Temporary Service
Nebraska. I understand that this permit is void if work is not commenced within 1 SO days
or is t completed within 2 years of date of issue. Mechanical
,~~cr~ e ~ ~ - I 1-9.3 Rough-in ABC
SIGNATURE OFOWNER/CONTRACTOR OR AUTHORIZED AGENT DATE Final
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approve By: _
~~
N11 INr1C PRT/:.Rlolr NF ReV. 1019
CITY OI' BLAIR
Application for Building Permit
PLOT PLAN
Address a ~ ~ E ~ D a ,~ v r a a ~ ~ { Date ~ - [ -1- ~ 3
Legal Description: Lot Block Addition
Please show all measurements of existing and contemplated structures,
also show distances :be•tween structures, etc., and property lines.
Is this a corner lot?
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rr,op ert V ~ L:Ln~ - '
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Center Line of
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Indicate North
S•treet_ _
Applicant ~(~~ C
W
BUILDING INSPECTION REPOR'
b~CITY OF BLAIR WASHINGTON COUNTY
LOCATION OF INSPECTIIO~~N.,: Z~L~ C ~CJr C)`(lC
NAME OF OWNER : ~~ l U1~~5~~~~-e,-~ CONTRACTORS
DATE INSPECTION REQUESTED: )Z'IC~'~'~ PER
TIME INSPECTION REQUESTED:
TYPE OF INSPECTION REQUESTED:
BUILDING:
FOOTING FRAMING
FINAL ~-°
UTILITIES:
SEWER TAP
WATER TAP
ELECTRICAL:
ROUGH IN:
SEWER
DRYWAL
~-~'~ ( ~
SEPTI
WATER SERVICE
FIXTURES
FINAL
REMO
PERMANENT SERVICE TEMPORARY SERVI
MECHANICAL: ROUGH-IN A\C FINAL
PLUMBING: GROUNDWORK ROUGH--IN FI
RESULTS OF THE INSPECTION: PASSED y (SEE NOTES)
NOTES\REMARKS:
INSPECTOR: .1 ,~`iy~~
DATE INSPECTION MADE: TIME:
CALLED OPPD\ TO CONNECT SERVICE: YES
WANT OFFICE STAFF TO CALL OPPD\ YES